2233 Seminole Rd #36 - Window Replacement CITY OF ATLANTIC BEACH
.7) 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
WINDOW AND /OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
JOB INFORMATION:
Job ID: 16- WIND -246
Job Type: WINDOW AND /OR DOOR
Description: WINDOW REPLMNT
Estimated Value: $2,345.00
Issue Date: 2/9/2016
Expiration Date: 8/7/2016
PROPERTY ADDRESS:
Address: 2233 SEMINOLE RD UNIT 036
RE Number: 169519 -0170
PROPERTY OWNER:
Name: NASRALLAH, KAREN V
Address: 2233 SEMINOLE RD APT 36
GENERAL CONTRACTOR INFORMATION:
Name: THD THE HOME DEPOT AT HOME
Address: 2690 CUMBERLAND PKWY STE 300 EDWARDO ESCUZA
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $30.86
BUILDING PERMIT FEE $61.73
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $96.59
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
, - 0- tw,, City of Atlantic Beach APPLICATION NUMBER
�' .,t Building Department
(To be assigned by the Building Department.)
• M °. Al 800 Seminole Road
Atlantic Beach, Florida 32233 - 5445 .. 441Vd ., a �/„
Phone (904) 247 -5826 • Fax (904) 247 -5845 �/
try j,3�'' E-mail: buildin de t coab.us
g p @ Date routed: GA il ,
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: X 23 3 fA/?4sJ � , � 6, Department review required Yes o
Building
Applicant: E f 'O t/' 4 , 17 , Pa�Zoning
Tree Administrator
Project: I'Ji2tn,sJ s't f /A E/tL f ,' T Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: pproved. 1 Denied.
(Circle one.) Comments:
:UILDING
PLANNING & ZONING ,31�j
Reviewed by: Date• l
TREE ADMIN. Second Review: pp
'Approved as revised. Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I (Approved as revised. 1 (Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
pteo�e Cali TM - P` -7a- -63
2-7- 4c L 5o77
BUILDING P ERMIT A PP L ICATION
F wA i CITY OF ATLANTIC BEACH r -- `f
� 800 Seminole Road, Atlantic Beach, FL 32233
12 C iew u � =
.. ..__ _ . Office (904) 247 -5826 Fax (904) 247 -5845 ''
Job Address: as 33 se M 0 ke ad c>n cr 3 C -36 Permit fl]er:FE8 - 1 1 11111
mot,.,, 1 I la
Description °9 -075 -a 9 /s Oce, lit flu- - e. ate - <o,, cl o M .n ✓r^ Parcel # - l `I - 6 D
w oor A rea o q. t. q. t cooled
Valuation of Work $ d3 Y 5 Proposed Work heated /cooled : . s
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window /door
Use of existing /proposed structure(s) (circle one): Commercial Residential
If an existing structure, is a fire sprinkler system installed? (Circle one): o 41/11
Florida Product Approval #
For multiple products use product approva orm
Describe in detail the type of work to be performed: Cef l o - `t C w, ^D"'s )(u -4( I rse
Property Owner Information:
Name: /<o -cer • /✓osSca,t( -k Address: a a 33 Sem,, '(e- to 6 '3 6
City AT lo. " 6 6 - . ) . State Fi Zip 3,4 Phone 90 (1-30"? - 0
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: III a 4-lame i fPtT Qualifying Agent: 'l; & t 1(o t
Address: 9'0 8 Flor.Lc- P.-A e. - City - To r PD State P1 Zip 33(19
Office Phone 7d7- 637 - fl) Job Site/ Contact Number Fax #
State Certification/Registration # C& ( /So 7 093
Architect Name & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. I cert that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in thu jurisdiction. This permit becomes null
and work is o commenced. of I understand that separate permits must be secur o ed for Electri Plumbing, Sig a Wells, P Boilers, Heaters,
Hea rs,
Tanks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTO O EMBEFORERECORDING YOUR NOTICE OF
T.
1 hereby certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal, state, or local law regulating construction or the performance of construction. �
( � Signature of Contractor Y., ature of Owner i5 p
Sign y-.'/
� � / � Print Name L L`�-OC t'�l�(U %� hint Name ``+... k ...... ... _.
Sworn to and subscribed before me Sworn to and subscribed before m
this Day of ��
20 this 1 sT Day of F s ! .
� ti , TIMOTHY j ' = 4'p , ..•y g�
l MY COMMISSION # FF 042794
Notary P - � �� tw RONALD AL -0t•FFF.�9i' u =.: '_ : • ugus , 1 117
Public NOTARY PUBLIC
' , ' ` ¢ Bonded Thru Notary Public Underwriters
STATE OF FLORIDA ' 1 - •.
. : , Comm# EE854609
Expires 12/29/2016
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2016 -01 -17 00:43 STR6365PRODESK 904201402 >> Home Depot AHS P 2/11
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